Are older adults the key to ending China's lockdowns?
Authors: None The Lancet Healthy Longevity
Journal: The Lancet Healthy Longevity (2022)

The emergence of a new wave of COVID-19 that rapidly spread throughout China in March, 2022, has seen cases reaching numbers similar to, or even worse than, those reported in Wuhan at the start of the pandemic. In an effort to curb infection rates, strict lockdown measures were implemented in Shanghai, Beijing, and other major cities in China, marked by roadblocks, closed businesses and schools, and mass community testing. Though successful in thwarting further outbreaks, these stringent zero-COVID restrictions have further destabilised the local economy, disrupting supply chains and shaking global markets. Food shortages and reduced access to health care have placed an enormous strain on residents, and the resulting psychological stress is reflected by an increasing demand for counselling services. In light of these severe consequences, the benefits and sustainability of the lockdowns must be challenged.China's zero-COVID aims to eradicate COVID-19, in contrast to other countries' strategies of living with the virus. The aim of a COVID-free China has resulted in a focus that possibly overlooks a crucial issue, namely the low vaccination rates in the older population. Despite accounting for the majority of SARS-CoV-2 infections, and COVID-related hospitalisations and deaths, older adults in China remain largely unvaccinated; as of May, 2022, in Shanghai, only 38% of adults aged 60 years or older have received three vaccine doses, and rates are even lower in those aged 80 years or older. Initial uncertainty regarding safety outcomes in older people, in part stemming from insufficient clinical trials assessing outcomes of domestic vaccines in this age group, resulted in early reluctance to get vaccinated. This hesitance was, in some cases, shared by physicians who advised older patients with chronic conditions against vaccination. However, a general distrust in vaccines predates the COVID-19 pandemic, spawned by scandals; in July, 2018, the Chinese vaccine production company Changsheng Biotechnology was found to have falsified inspection data for a rabies vaccine and to have manufactured ineffective diphtheria, pertussis, and tetanus vaccines for children and infants. The fractured trust in domestic vaccine development has led many older people, already wary about safety concerns and often with a preference for traditional medicine, to refuse COVID-19 vaccination. Those older adults who do seek to get vaccinated often have difficulties in accessing vaccination centres due to limited mobility, especially those residing in rural areas. Though the low vaccine uptake could be misconstrued as the result of neglect, or even ageism, it instead might reflect the deference for older people ingrained in Chinese culture—in accordance with which, older people are afforded autonomy to make decisions about their health.The initial safety concerns that aimed to shield older people have now left them even more vulnerable. As was characteristic of other waves of SARS-CoV-2, older people have been most susceptible to infection, resulting in high rates of older people residing in mandated quarantine in overcrowded makeshift centres, often under unsanitary conditions. Older adults have also been particularly affected by lockdowns, which have exacerbated loneliness and restricted access to basic needs, including health care for chronic conditions. The increasing reliance on technology to navigate lockdowns, such as online shopping for food and the use of QR codes, has further isolated older people, many of whom have low digital literacy or do not have access to smartphones.Governments are now scrambling to vaccinate the older population—eg, in the Guangdong province teachers are mandated to aid in vaccinating four people aged older than 60 years. However, the tight restrictions cannot be sustained and the quixotic aspiration of a world without COVID is fruitless. Instead, lockdowns should be supplanted, or at the very least supplemented, by expanding campaigns to promote vaccination uptake in older people. This endeavour requires ongoing research on the safety outcomes of vaccines in older people, especially those with chronic conditions, and clear messaging about the risks and benefits of vaccines relative to the risks of infection.The monetary and human costs of rigid restrictions in China make a viable exit strategy increasingly urgent. Ensuring that older people are vaccinated is one of the key measures that might help ease the extreme lockdowns being endured by many. To guarantee that, as noted by President Xi Jinping, “No effort should be spared…to truly respect the value and dignity of every human life”, vaccinating the elderly should be a priority. The emergence of a new wave of COVID-19 that rapidly spread throughout China in March, 2022, has seen cases reaching numbers similar to, or even worse than, those reported in Wuhan at the start of the pandemic. In an effort to curb infection rates, strict lockdown measures were implemented in Shanghai, Beijing, and other major cities in China, marked by roadblocks, closed businesses and schools, and mass community testing. Though successful in thwarting further outbreaks, these stringent zero-COVID restrictions have further destabilised the local economy, disrupting supply chains and shaking global markets. Food shortages and reduced access to health care have placed an enormous strain on residents, and the resulting psychological stress is reflected by an increasing demand for counselling services. In light of these severe consequences, the benefits and sustainability of the lockdowns must be challenged. China's zero-COVID aims to eradicate COVID-19, in contrast to other countries' strategies of living with the virus. The aim of a COVID-free China has resulted in a focus that possibly overlooks a crucial issue, namely the low vaccination rates in the older population. Despite accounting for the majority of SARS-CoV-2 infections, and COVID-related hospitalisations and deaths, older adults in China remain largely unvaccinated; as of May, 2022, in Shanghai, only 38% of adults aged 60 years or older have received three vaccine doses, and rates are even lower in those aged 80 years or older. Initial uncertainty regarding safety outcomes in older people, in part stemming from insufficient clinical trials assessing outcomes of domestic vaccines in this age group, resulted in early reluctance to get vaccinated. This hesitance was, in some cases, shared by physicians who advised older patients with chronic conditions against vaccination. However, a general distrust in vaccines predates the COVID-19 pandemic, spawned by scandals; in July, 2018, the Chinese vaccine production company Changsheng Biotechnology was found to have falsified inspection data for a rabies vaccine and to have manufactured ineffective diphtheria, pertussis, and tetanus vaccines for children and infants. The fractured trust in domestic vaccine development has led many older people, already wary about safety concerns and often with a preference for traditional medicine, to refuse COVID-19 vaccination. Those older adults who do seek to get vaccinated often have difficulties in accessing vaccination centres due to limited mobility, especially those residing in rural areas. Though the low vaccine uptake could be misconstrued as the result of neglect, or even ageism, it instead might reflect the deference for older people ingrained in Chinese culture—in accordance with which, older people are afforded autonomy to make decisions about their health. The initial safety concerns that aimed to shield older people have now left them even more vulnerable. As was characteristic of other waves of SARS-CoV-2, older people have been most susceptible to infection, resulting in high rates of older people residing in mandated quarantine in overcrowded makeshift centres, often under unsanitary conditions. Older adults have also been particularly affected by lockdowns, which have exacerbated loneliness and restricted access to basic needs, including health care for chronic conditions. The increasing reliance on technology to navigate lockdowns, such as online shopping for food and the use of QR codes, has further isolated older people, many of whom have low digital literacy or do not have access to smartphones. Governments are now scrambling to vaccinate the older population—eg, in the Guangdong province teachers are mandated to aid in vaccinating four people aged older than 60 years. However, the tight restrictions cannot be sustained and the quixotic aspiration of a world without COVID is fruitless. Instead, lockdowns should be supplanted, or at the very least supplemented, by expanding campaigns to promote vaccination uptake in older people. This endeavour requires ongoing research on the safety outcomes of vaccines in older people, especially those with chronic conditions, and clear messaging about the risks and benefits of vaccines relative to the risks of infection. The monetary and human costs of rigid restrictions in China make a viable exit strategy increasingly urgent. Ensuring that older people are vaccinated is one of the key measures that might help ease the extreme lockdowns being endured by many. To guarantee that, as noted by President Xi Jinping, “No effort should be spared…to truly respect the value and dignity of every human life”, vaccinating the elderly should be a priority.